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Effectiveness of a new cardiac risk scoring model reclassified by QRS fragmentation as a predictor of postoperative cardiac event in patients with severe renal dysfunction
- Source :
- BMC Cardiovascular Disorders, BMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-8 (2021)
- Publication Year :
- 2021
-
Abstract
- Background It is difficult to evaluate the risk of patients with severe renal dysfunction before surgery due to various limitations despite high postoperative cardiac events. This study aimed to investigate the value of a newly reclassified Revised Cardiac Risk Index (RCRI) that incorporates QRS fragmentation (fQRS) as a predictor of postoperative cardiac events in patients with severe renal dysfunction. Methods Among the patients with severe renal dysfunction, 256 consecutive patients who underwent both a nuclear stress test and noncardiac surgery were evaluated. We reclassified RCRI as fragmented RCRI (FRCRI) by integrating fQRS on electrocardiography. We defined postoperative major adverse cardiac event (MACE) as a composite of cardiac death, nonfatal myocardial infarction, and pulmonary edema. Results Twenty-eight patients (10.9%) developed postoperative MACE, and this was significantly frequent in patients with myocardial perfusion defect (41.4% vs. 28.0%, p = 0.031). fQRS was observed 84 (32.8%) patients, and it was proven to be an independent predictor of postoperative MACE after adjusting for the RCRI (odds ratio 3.279, 95% confidence interval (CI) 1.419–7.580, p = 0.005). Moreover, fQRS had an incremental prognostic value for the RCRI (chi-square = 7.8, p = 0.005), and to the combination of RCRI and age (chi-square = 9.1, p = 0.003). The area under curve for predicting postoperative MACE significantly increased from 0.612 for RCRI to 0.667 for FRCRI (p = 0.027) and 23 patients (32.4%) originally classified as RCRI 2 were reclassified as FRCRI 3. Conclusions A newly reclassified FRCRI that incorporates fQRS, is a valuable predictor of postoperative MACE in patients with severe renal dysfunction undergoing noncardiac surgery.
- Subjects :
- Male
medicine.medical_specialty
Heart Diseases
Revised Cardiac Risk Index
Myocardial Ischemia
Severe renal dysfunction
030204 cardiovascular system & hematology
Kidney
Risk Assessment
Severity of Illness Index
Decision Support Techniques
03 medical and health sciences
Electrocardiography
Postoperative cardiac complication
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Diseases of the circulatory (Cardiovascular) system
Humans
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Angiology
Aged
Retrospective Studies
Aged, 80 and over
Tomography, Emission-Computed, Single-Photon
medicine.diagnostic_test
business.industry
Research
Myocardial Perfusion Imaging
Odds ratio
Middle Aged
medicine.disease
Fragmented QRS
Confidence interval
Cardiac surgery
Treatment Outcome
RC666-701
Surgical Procedures, Operative
Cardiology
Female
Kidney Diseases
Cardiology and Cardiovascular Medicine
business
Mace
Subjects
Details
- ISSN :
- 14712261
- Volume :
- 21
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC cardiovascular disorders
- Accession number :
- edsair.doi.dedup.....8b7ed1a8ae66135579cd83c20b63c13d